INTRODUCTION: Adductor canal block (ACB) is hypothesised to provide superior analgesia to femoral nerve block (FNB) for total knee arthroplasty (TKA) while preserving quadriceps strength. METHODS: 30 patients undergoing TKA were randomised to receive either ACB or FNB. Baseline tests of quadriceps strength were performed. Ultrasound-guided blocks with 30 mL of 0.5% ropivacaine were administered before induction of general anaesthesia. Patient-controlled analgesia (morphine) was prescribed for postoperative analgesia. The primary outcome of this prospective, double-blinded, randomised controlled trial was morphine consumption (mean ± standard deviation) in the first 24 hours. Secondary outcomes were pain scores using a numeric rating scale (median and interquartile range [IQR]), quadriceps strength (% of baseline) and functional outcomes at 24 hours and 48 hours postoperatively. RESULTS: There was no statistically significant difference in morphine consumption at 24 hours between the ACB and FNB groups (21 ± 11 mg vs. 20 ± 12 mg; p = 0.85). No statistically significant differences were observed between the ACB and FNB groups in pain scores at 24 hours (at rest: 0 [IQR 0-2] vs. 0 [IQR 0-2]; on movement: 5 [IQR 4-8] vs. 5 [IQR 3-8]) and quadriceps strength (24 hours: 28.8% ± 26.1% vs. 26.8% ± 19.6% of baseline; 48 hours: 31.5 ± 23.1% vs. 33.7% ± 20.1% of baseline). There were also no statistically significant differences in functional outcomes and length of stay. CONCLUSION We found no statistically significant differences in analgesic effects, quadriceps strength or functional recovery postoperatively between ACB and FNB.
Aged ; Aged, 80 and over ; Analgesia, Patient-Controlled ; methods ; Analgesics, Opioid ; therapeutic use ; Anesthetics, Local ; administration & dosage ; Arthroplasty, Replacement, Knee ; Double-Blind Method ; Female ; Femoral Nerve ; Humans ; Male ; Middle Aged ; Morphine ; therapeutic use ; Nerve Block ; methods ; Pain Management ; methods ; Pain Measurement ; Pain, Postoperative ; drug therapy ; Prospective Studies ; Quadriceps Muscle ; drug effects ; Treatment Outcome ; Ultrasonography

PURPOSE: To compare the clinical outcomes of single injection adductor canal block (SACB), continuous adductor canal block (CACB), and the concomitant use of transdermal buprenorphine after total knee arthroplasty (TKA). MATERIALS AND METHODS: A total of 125 patients who underwent TKA were divided into three groups and the clinical results were retrospecitively compared. Group I was comprised of patients with pain controlled by SACB (n=41). Group II consisted of patients with pain controlled by both SACB and transdermal buprenorphine (10 µg/h) (n=44). Group III contained patients with pain controlled by CACB (n=40). The visual analogue scale (VAS) was used as the pain control indicator and the patients were measured on a VAS for resting on the bed (VAS-Rest) at 12 hours, 24 hours, and 48 hours after surgery. The VAS while doing continuous passive motion (VAS-CPM) on the first and second postoperative day was also measured. In addition, the total amount of medications used (Butopahn, Tridol, and Ketorac) for the intravenous patient controlled analgesia (PCA) was counted for 48 hours after surgery. As the indicator of the functional recovery outcome, the incidence of nausea and vomiting was observed for 48 hours after surgery. The maximum knee joint flexion range and maximum walking distance on the first and second postoperative day, and the total length of stay at the hospital were compared. RESULTS: The VAS-Rest was similar in the three groups at 12 hours after surgery, but at 24 hours and 48 hours after surgery, group II and III a lower VAS-CPM and total amount of medications used for PCA than group I (p<0.05). The three groups showed a low incidence of nausea and vomiting, maximum knee joint flexion range, and similar walking distance and total length of stay at the hospital. CONCLUSION: The combination of SACB and transdermal buprenorphine has great pain control effect initially. On the other hand, it is not associated with catheter complications and it is convenient to use and safety toward the renal function. Therefore, the concomitant use of SACB and transdermal buprenorphine can be an effective pain control method after TKA.
Analgesia, Patient-Controlled ; Arthroplasty, Replacement, Knee ; Buprenorphine ; Catheters ; Hand ; Humans ; Incidence ; Knee Joint ; Length of Stay ; Methods ; Nausea ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Vomiting ; Walking

BACKGROUND: Patient-controlled epidural analgesia (PCEA) is known to provide good postoperative analgesia in many types of surgery including laparoscopic surgery. However, no study has compared PCEA with patient-controlled intravascular analgesia (PCIA) in laparoscopic radical prostatectomy (LARP). In this study, the efficacy and side effects of PCEA and PCIA after LARP were compared. METHODS: Forty patients undergoing LARP were randomly divided into two groups: 1) a PCEA group, treated with 0.2% ropivacaine 3 ml and 0.1 mg morphine in the bolus; and 2) a PCIA group, treated with oxycodone 1 mg and nefopam 1 mg in the bolus. After the operation, a blinded observer assessed estimated blood loss (EBL), added a dose of rocuronium, performed transfusion, and added analgesics. The numeric rating scale (NRS), infused PCA dose, and side effects were assessed at 1, 6, 24, and 48 h. RESULTS: EBL, added rocuronium, and added analgesics in the PCEA group were less than those in the PCIA group. There were no significant differences in side-effects after the operation between the two groups. Patients were more satisfied with PCEA than with PCIA. The NRS and accumulated PCA count were lower in PCEA group. CONCLUSIONS: Combined thoracic epidural anesthesia could induce less blood loss during operations. PCEA showed better postoperative analgesia and greater patient satisfaction than PCIA. Thus, PCEA may be a more useful analgesic method than PICA after LARP.
Administration, Intravenous ; Analgesia ; Analgesia, Epidural ; Analgesia, Patient-Controlled ; Analgesics ; Anesthesia, Epidural ; Humans ; Injections, Epidural ; Laparoscopes ; Laparoscopy ; Methods ; Morphine ; Nefopam ; Oxycodone ; Pain Measurement ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Patient Satisfaction ; Pica ; Prostatectomy ; Thoracic Vertebrae

Patient controlled epidural anlagesia is a commonly used method for postoperative pain management. The purpose of this study is to determine the optimal concentration of sufentanil for patient controlled epidural analgesia. Twenty eight patients who underwent elective gastrectomy were enrolled in this study. Patients were randomly assigned to one of two groups of 0.5 µg/mL (group S1) and 0.7 µg/mL (group S2). At 2 hours, 1 day, 2 days and 3 days after surgery, the patient's pain degree was checked by numerical rating scale (NRS) and the presence of side effects was assessed. In both groups, the NRS decreased linearly with time. The NRS of the two groups differed but the trend of decrease did not show significant difference. The overall incidence of side effects was 45.5% (group S1) and 58.8% (group S2), respectively. Patient controlled epidural analgesia using sufentanil was effective in controlling postoperative pain, which was found to decrease with time. When comparing the two concentrations used in this study, 0.5 µg/mL had a lower incidence of side effects than the concentration of 0.7 µg/mL, and the pain relief trends of the two concentrations were similar.
Analgesia, Epidural* ; Analgesia, Patient-Controlled ; Gastrectomy* ; Humans ; Incidence ; Methods ; Pain, Postoperative ; Sufentanil*

Neuraxial analgesia is the gold standard method for pain relief in labor. Several techniques can optimize both the initiation and maintenance of neuraxial labor analgesia. Initiation techniques such as combined spinal-epidural or dural puncture epidural may offer some advantages over standard epidural insertion. The use of ultrasound to assist with landmarking and optimizing block placement improves neuraxial success, and is particularly useful in certain patient populations. Maintaining labor analgesia with a regimen that includes background programmed intermittent boluses with a patient-controlled epidural analgesia component affords the best combination of pain relief and avoidance of undesired effects. These techniques are most effective when dilute local anesthetics with lipophilic opioids are utilized.
Analgesia* ; Analgesia, Epidural ; Analgesia, Obstetrical ; Analgesia, Patient-Controlled ; Analgesics, Opioid ; Anesthetics, Local ; Humans ; Methods ; Pain Management ; Punctures ; Ultrasonography

STUDY DESIGN: Prospective study. OBJECTIVES: This study compared the early postoperative analgesic effects and the postoperative nausea and vomiting (PONV) associated with 3 methods of pain control after posterior spinal decompression. SUMMARY OF LITERATURE REVIEW: Spinal surgery causes severe postoperative pain. Efficient and safe methods for postoperative analgesia after spinal surgery are necessary. MATERIALS AND METHODS: To determine the clinical symptoms and to assess improvements in postoperative pain, 52 patients in whom single-level posterior lumbar decompression was planned were randomly assigned to 3 groups. For postoperative pain control, 18 patients received a preoperative single-shot epidural injection (SEI), 16 patients received a postoperative continuous epidural injection (CEI), and 18 patients received only postoperative intravenous patient-controlled analgesia (IV-PCA). Patient ratings of pain intensity (visual analog scale score from 0 [no pain] to 10 [most severe pain]), nausea (from 0 [no nausea] to 5 [severe nausea]), and vomiting (from 0 [no vomiting] to 5 [severe vomiting]) were recorded immediately after the operation and at 4 hours, 12 hours, 1 day, and 2 days postoperatively. RESULTS: The CEI group showed significantly enhanced analgesic effects, followed by the SEI group and the IV PCA group (p < 0.05). PONV due to postoperative pain control was more severe in the IV PCA group than in the other 2 groups (p < 0.05). CONCLUSIONS: Continuous epidural injection (CEI) is effective for postoperative pain control and minimizes the occurrence of PONV after posterior spinal decompression.
Analgesia ; Analgesia, Patient-Controlled ; Decompression ; Humans ; Injections, Epidural ; Methods ; Nausea ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Postoperative Nausea and Vomiting ; Prospective Studies ; Spinal Stenosis ; Vomiting

OBJECTIVETo compare the postoperative analgesia efficacy, rehabilitation parameters and complication between multimodal analgesia and traditional analgesia after radical gastrectomy for gastric cancer patients.

METHODSPatients with gastric cancer who underwent surgery in our hospital from October 2016 to December 2016 were enrolled in this prospective study. According to the non-randomized method, patients were assigned to multimodal analgesia group(n=32) and traditional analgesia group(n=33) in gastric cancer treatment team A and B in Department of Gastrointestinal Surgery, West China Hospital, Sichuan University. The treatment measures of group A were as follows: (1) The ratio of 1/1 diluted ropivacaine (100 mg, 10 ml) was infiltrated around the incision before abdomen closure, with incision sutured layer by layer. (2) Parecoxib sodium (40 mg) was injected intravenously every 12 hours after operation for 5 days. (3) Oxycodone-acetaminophen tablet was given orally on the first day or the second day after operation, 50 mg twice a day. (4) Patient-controlled analgesia was not used after operation. Patients in group B received direct suture of incision and patient-controlled analgesia. The pain score, postoperative rehabilitation and 30-day postoperative complications were collected and analyzed.

RESULTSMultimodal analgesia group had lower pain scores at 1 d (4.8±0.9), 2 d (4.3±1.0), 3 d (2.9±0.8), 4 d (2.4±0.7) and 5 d (1.7±0.7) after surgery, as compared to traditional analgesia group (5.9±0.9, P=0.000), (5.1±0.7, P=0.001), (3.9±0.8, P=0.000), (3.0±0.6, P=0.000), (2.6±0.7, P=0.000), with significant difference. Postoperative hospital stay [(8.2±1.6) days vs. (10.6±2.2) days, P=0.000], time to ambulation [(47.5±13.8) days vs. (66.2±16.8) days, P=0.000], time to first flatus [(76.4±25.2) days vs. (120.0±29.9) days, P=0.000], time to first defecate [(117.3±42.2) days vs. (159.7±30.7) days, P=0.000] and time to first fluid diet [(83.8±21.6) days vs. (141.9±33.9) days, P=0.000] in the multimodal analgesia group were significantly shorter than those in the traditional analgesia group. There was no significant difference between the two groups with respect to 30-day postoperative complication rate(9.4% vs. 9.1%, P=1.000).

CONCLUSIONSMultimodal analgesia can significantly reduce the postoperative pain and is beneficial to rehabilitation, meanwhile it does not increase the risk of postoperative complications. Multimodal analgesia is safe and effective for gastric cancer patients undergoing radical gastrectomy.

Acetaminophen ; administration & dosage ; therapeutic use ; Amides ; administration & dosage ; therapeutic use ; Analgesia, Patient-Controlled ; China ; Comparative Effectiveness Research ; Defecation ; Drug Combinations ; Eating ; Flatulence ; Gastrectomy ; rehabilitation ; Humans ; Isoxazoles ; administration & dosage ; therapeutic use ; Length of Stay ; statistics & numerical data ; Oxycodone ; administration & dosage ; therapeutic use ; Pain Management ; methods ; Pain, Postoperative ; drug therapy ; Postoperative Complications ; Prospective Studies ; Recovery of Function ; drug effects ; Stomach Neoplasms ; surgery ; Surgical Wound ; rehabilitation ; therapy ; Suture Techniques ; Treatment Outcome ; Walking

PURPOSE: Postoperative nausea and vomiting (PONV) is very common among postoperative orthopedic surgical patients with patient-controlled analgesia (PCA), especially for narcotics. Therefore, the purpose of this study was to investigate the effects of an evidence-based PONV management protocol on nursing and patient outcomes. METHODS: A methodological study was conducted to develop PONV protocol and a quasi-experimental study to evaluate the effectiveness of protocol. The preliminary PONV protocol was drawn by conducting a systematic review and by reviewing clinical guidelines and best practice recommendations. Validation of the content was done by expert clinicians, and the clinical applicability was evaluated by staff nurses and patients. The effect was evaluated in clinical outcomes associated with PONV and nursing outcomes. RESULTS: In the experimental group, the occurrence of vomiting (z=2.147) was significantly decreased, the maintenance PCA (χ²=4.212) and the satisfaction of patients (z=5.007) were significantly higher. In the outcomes of nurses, the PONV knowledge of nursing care (z=3.791), awareness (z=2.982) and self-efficacy (z=2.745) were higher in the experimental group. The attitude towards evidence-based nursing practice (z=2.446) was significantly positive. CONCLUSION: The results show that an evidence-based approach to the implementation of PONV care is effective in improving patient clinical outcomes and quality of care.
Analgesia, Patient-Controlled ; Clinical Protocols ; Evidence-Based Nursing* ; Humans ; Methods ; Narcotics ; Non-Randomized Controlled Trials as Topic ; Nursing ; Nursing Care ; Orthopedics ; Passive Cutaneous Anaphylaxis ; Postoperative Nausea and Vomiting* ; Practice Guidelines as Topic ; Program Development ; Program Evaluation ; Vomiting

PURPOSE: The purpose of this study was to develop a smartphone app for use in patient controlled analgesia (PCA) education and to identify PCA knowledge and pain management following lower extremity orthopaedic surgery under spinal anesthesia in patients who received smartphone app education. METHODS: Participants were 150 patients in an orthopaedic hospital located in Busan. The measurement variables used in this study were PCA knowledge, pain management and pain level. For data analysis, SPSS/WIN 21.0 program was used in the analysis of the relation of frequencies. In addition, percentage, mean and standard deviation, t-test, ANOVA, Duncan, Pearson's correlation coefficients were also assessed. RESULTS: The score for knowledge regarding PCA was 4.27±1.64. The correlations between knowledge and pain management (button push times Analgesia ; Analgesia, Patient-Controlled* ; Anesthesia, Spinal* ; Busan ; Education* ; Humans ; Lower Extremity* ; Methods ; Mobile Applications ; Orthopedics* ; Pain Management* ; Passive Cutaneous Anaphylaxis ; Smartphone* ; Statistics as Topic

BACKGROUND: There is a need for investigating the analgesic method as part of early recovery after surgery tailored for laparoscopic colorectal cancer (LCRC) surgery. In this randomized trial, we aimed to investigate the analgesic efficacy of an inverse ‘v’ shaped bilateral, subfascial ropivacaine continuous infusion in LCRC surgery. METHODS: Forty two patients undergoing elective LCRC surgery were randomly allocated to one of two groups to receive either 0.5% ropivacaine continuous infusion at the subfascial plane (n = 20, R group) or fentanyl intravenous patient controlled analgesia (IV PCA) (n = 22, F group) for postoperative 72 hours. The primary endpoint was the visual analogue scores (VAS) when coughing at postoperative 24 hours. Secondary end points were the VAS at 1, 6, 48, and 72 hours, time to first flatus, time to first rescue meperidine requirement, rescue meperidine consumption, length of hospital stay, postoperative nausea and vomiting, sedation, hypotension, dizziness, headache, and wound complications. RESULTS: The VAS at rest and when coughing were similar between the groups throughout the study. The time to first gas passage and time to first rescue meperidine at ward were significantly shorter in the R group compared to the F group (P = 0.010). Rescue meperidine was administered less in the R group; however, without statistical significance. Other study parameters were not different between the groups. CONCLUSIONS: Ropivacaine continuous infusion with an inverse ‘v ’ shaped bilateral, subfascial catheter placement showed significantly enhanced bowel recovery and analgesic efficacy was not different from IV PCA in LCRC surgery.
Analgesia ; Analgesia, Patient-Controlled ; Anesthetics, Local ; Catheters ; Colorectal Neoplasms* ; Colorectal Surgery ; Cough ; Dizziness ; Fentanyl ; Flatulence ; Headache ; Humans ; Hypotension ; Laparoscopy ; Length of Stay ; Meperidine ; Methods ; Passive Cutaneous Anaphylaxis ; Postoperative Nausea and Vomiting ; Wounds and Injuries